Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial

Louise Lundby-Christensen; Lise Tarnow; Trine W Boesgaard; Søren S. Lund; Niels Wiinberg; Hans Perrild; Thure Krarup; Ole Snorgaard; Birthe Gade-Rasmussen; Birger Thorsteinsson; Michael Røder; Elisabeth R Mathiesen; Tonny Jensen; Henrik Vestergaard; Christoffer Hedetoft; Leif Breum; Elsebeth Duun; Simone B Sneppen; Oluf Pedersen; Bianca Hemmingsen; Bendix Carstensen; Sten Madsbad; Christian Gluud; Jørn Wetterslev; Allan Vaag; Thomas P Almdal

doi:10.1136/bmjopen-2015-008376

Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial

Louise Lundby-Christensen, Lise Tarnow, Trine W Boesgaard, Søren S. Lund, Niels Wiinberg, Hans Perrild, Thure Krarup, Ole Snorgaard, Birthe Gade-Rasmussen, Birger Thorsteinsson, Michael Røder, Elisabeth R Mathiesen, Tonny Jensen, Henrik Vestergaard, Christoffer Hedetoft, Leif Breum, Elsebeth Duun, Simone B Sneppen, Oluf Pedersen, Bianca HemmingsenBendix Carstensen, Sten Madsbad, Christian Gluud, Jørn Wetterslev, Allan Vaag, Thomas P Almdal

29 Citations (Scopus)

Abstract

Objective: To assess the effect of metformin versus placebo both in combination with insulin analogue treatment on changes in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Design and setting: Investigator-initiated, randomised, placebo-controlled trial with a 2×3 factorial design conducted at eight hospitals in Denmark. Participants and interventions: 412 participants with type 2 diabetes (glycated haemoglobin (HbA_1c) ≥7.5% (≥58 mmol/mol); body mass index >25 kg/m2) were in addition to open-labelled insulin treatment randomly assigned 1:1 to 18 months blinded metformin (1 g twice daily) versus placebo, aiming at an HbA_1c ≤7.0% (≤53 mmol/mol). Outcomes: The primary outcome was change in the mean carotid IMT (a marker of subclinical cardiovascular disease). HbA_1c, insulin dose, weight and hypoglycaemic and serious adverse events were other prespecified outcomes. Results: Change in the mean carotid IMT did not differ significantly between the groups (betweengroup difference 0.012 mm (95% CI -0.003 to 0.026), p=0.11). HbA_1c was more reduced in the metformin group (between-group difference.0.42% (95% CI.0.62% to.0.23%), p<0.001)), despite the significantly lower insulin dose at end of trial in the metformin group (1.04 IU/kg (95% CI 0.94 to 1.15)) compared with placebo (1.36 IU/kg (95% CI 1.23 to 1.51), p<0.001). The metformin group gained less weight (between-group difference -2.6 kg (95% CI -3.3 to -1.8), p<0.001). The groups did not differ with regard to number of patients with severe or non-severe hypoglycaemic or other serious adverse events, but the metformin group had more nonsevere hypoglycaemic episodes (4347 vs 3161, p<0.001). Conclusions: Metformin in combination with insulin did not reduce carotid IMT despite larger reduction in HbA1c, less weight gain, and smaller insulin dose compared with placebo plus insulin. However, the trial only reached 46% of the planned sample size and lack of power may therefore have affected our results.

Original language	English
Article number	e008376
Journal	B M J Open
Volume	6
Issue number	2
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2015-008376
Publication status	Published - 2016

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Lundby-Christensen, L., Tarnow, L., Boesgaard, T. W., Lund, S. S., Wiinberg, N., Perrild, H., Krarup, T., Snorgaard, O., Gade-Rasmussen, B., Thorsteinsson, B., Røder, M., Mathiesen, E. R., Jensen, T., Vestergaard, H., Hedetoft, C., Breum, L., Duun, E., Sneppen, S. B., Pedersen, O., ... Almdal, T. P. (2016). Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial. B M J Open, 6(2), [e008376]. https://doi.org/10.1136/bmjopen-2015-008376

Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus : the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial. / Lundby-Christensen, Louise; Tarnow, Lise; Boesgaard, Trine W et al.

In: B M J Open, Vol. 6, No. 2, e008376, 2016.

Research output: Contribution to journal › Journal article › Research › peer-review

Lundby-Christensen, L, Tarnow, L, Boesgaard, TW, Lund, SS, Wiinberg, N, Perrild, H, Krarup, T, Snorgaard, O, Gade-Rasmussen, B, Thorsteinsson, B, Røder, M, Mathiesen, ER, Jensen, T, Vestergaard, H, Hedetoft, C, Breum, L, Duun, E, Sneppen, SB, Pedersen, O, Hemmingsen, B, Carstensen, B , Madsbad, S, Gluud, C, Wetterslev, J, Vaag, A & Almdal, TP 2016, 'Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial', B M J Open, vol. 6, no. 2, e008376. https://doi.org/10.1136/bmjopen-2015-008376

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title = "Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial",

abstract = "Objective: To assess the effect of metformin versus placebo both in combination with insulin analogue treatment on changes in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Design and setting: Investigator-initiated, randomised, placebo-controlled trial with a 2×3 factorial design conducted at eight hospitals in Denmark. Participants and interventions: 412 participants with type 2 diabetes (glycated haemoglobin (HbA1c) ≥7.5% (≥58 mmol/mol); body mass index >25 kg/m2) were in addition to open-labelled insulin treatment randomly assigned 1:1 to 18 months blinded metformin (1 g twice daily) versus placebo, aiming at an HbA1c ≤7.0% (≤53 mmol/mol). Outcomes: The primary outcome was change in the mean carotid IMT (a marker of subclinical cardiovascular disease). HbA1c, insulin dose, weight and hypoglycaemic and serious adverse events were other prespecified outcomes. Results: Change in the mean carotid IMT did not differ significantly between the groups (betweengroup difference 0.012 mm (95% CI -0.003 to 0.026), p=0.11). HbA1c was more reduced in the metformin group (between-group difference.0.42% (95% CI.0.62% to.0.23%), p<0.001)), despite the significantly lower insulin dose at end of trial in the metformin group (1.04 IU/kg (95% CI 0.94 to 1.15)) compared with placebo (1.36 IU/kg (95% CI 1.23 to 1.51), p<0.001). The metformin group gained less weight (between-group difference -2.6 kg (95% CI -3.3 to -1.8), p<0.001). The groups did not differ with regard to number of patients with severe or non-severe hypoglycaemic or other serious adverse events, but the metformin group had more nonsevere hypoglycaemic episodes (4347 vs 3161, p<0.001). Conclusions: Metformin in combination with insulin did not reduce carotid IMT despite larger reduction in HbA1c, less weight gain, and smaller insulin dose compared with placebo plus insulin. However, the trial only reached 46% of the planned sample size and lack of power may therefore have affected our results.",

author = "Louise Lundby-Christensen and Lise Tarnow and Boesgaard, {Trine W} and Lund, {S{\o}ren S.} and Niels Wiinberg and Hans Perrild and Thure Krarup and Ole Snorgaard and Birthe Gade-Rasmussen and Birger Thorsteinsson and Michael R{\o}der and Mathiesen, {Elisabeth R} and Tonny Jensen and Henrik Vestergaard and Christoffer Hedetoft and Leif Breum and Elsebeth Duun and Sneppen, {Simone B} and Oluf Pedersen and Bianca Hemmingsen and Bendix Carstensen and Sten Madsbad and Christian Gluud and J{\o}rn Wetterslev and Allan Vaag and Almdal, {Thomas P}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

doi = "10.1136/bmjopen-2015-008376",

language = "English",

volume = "6",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "2",

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TY - JOUR

T1 - Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus

T2 - the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial

AU - Lundby-Christensen, Louise

AU - Tarnow, Lise

AU - Boesgaard, Trine W

AU - Lund, Søren S.

AU - Wiinberg, Niels

AU - Perrild, Hans

AU - Krarup, Thure

AU - Snorgaard, Ole

AU - Gade-Rasmussen, Birthe

AU - Thorsteinsson, Birger

AU - Røder, Michael

AU - Mathiesen, Elisabeth R

AU - Jensen, Tonny

AU - Vestergaard, Henrik

AU - Hedetoft, Christoffer

AU - Breum, Leif

AU - Duun, Elsebeth

AU - Sneppen, Simone B

AU - Pedersen, Oluf

AU - Hemmingsen, Bianca

AU - Carstensen, Bendix

AU - Madsbad, Sten

AU - Gluud, Christian

AU - Wetterslev, Jørn

AU - Vaag, Allan

AU - Almdal, Thomas P

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016

Y1 - 2016

N2 - Objective: To assess the effect of metformin versus placebo both in combination with insulin analogue treatment on changes in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Design and setting: Investigator-initiated, randomised, placebo-controlled trial with a 2×3 factorial design conducted at eight hospitals in Denmark. Participants and interventions: 412 participants with type 2 diabetes (glycated haemoglobin (HbA1c) ≥7.5% (≥58 mmol/mol); body mass index >25 kg/m2) were in addition to open-labelled insulin treatment randomly assigned 1:1 to 18 months blinded metformin (1 g twice daily) versus placebo, aiming at an HbA1c ≤7.0% (≤53 mmol/mol). Outcomes: The primary outcome was change in the mean carotid IMT (a marker of subclinical cardiovascular disease). HbA1c, insulin dose, weight and hypoglycaemic and serious adverse events were other prespecified outcomes. Results: Change in the mean carotid IMT did not differ significantly between the groups (betweengroup difference 0.012 mm (95% CI -0.003 to 0.026), p=0.11). HbA1c was more reduced in the metformin group (between-group difference.0.42% (95% CI.0.62% to.0.23%), p<0.001)), despite the significantly lower insulin dose at end of trial in the metformin group (1.04 IU/kg (95% CI 0.94 to 1.15)) compared with placebo (1.36 IU/kg (95% CI 1.23 to 1.51), p<0.001). The metformin group gained less weight (between-group difference -2.6 kg (95% CI -3.3 to -1.8), p<0.001). The groups did not differ with regard to number of patients with severe or non-severe hypoglycaemic or other serious adverse events, but the metformin group had more nonsevere hypoglycaemic episodes (4347 vs 3161, p<0.001). Conclusions: Metformin in combination with insulin did not reduce carotid IMT despite larger reduction in HbA1c, less weight gain, and smaller insulin dose compared with placebo plus insulin. However, the trial only reached 46% of the planned sample size and lack of power may therefore have affected our results.

AB - Objective: To assess the effect of metformin versus placebo both in combination with insulin analogue treatment on changes in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Design and setting: Investigator-initiated, randomised, placebo-controlled trial with a 2×3 factorial design conducted at eight hospitals in Denmark. Participants and interventions: 412 participants with type 2 diabetes (glycated haemoglobin (HbA1c) ≥7.5% (≥58 mmol/mol); body mass index >25 kg/m2) were in addition to open-labelled insulin treatment randomly assigned 1:1 to 18 months blinded metformin (1 g twice daily) versus placebo, aiming at an HbA1c ≤7.0% (≤53 mmol/mol). Outcomes: The primary outcome was change in the mean carotid IMT (a marker of subclinical cardiovascular disease). HbA1c, insulin dose, weight and hypoglycaemic and serious adverse events were other prespecified outcomes. Results: Change in the mean carotid IMT did not differ significantly between the groups (betweengroup difference 0.012 mm (95% CI -0.003 to 0.026), p=0.11). HbA1c was more reduced in the metformin group (between-group difference.0.42% (95% CI.0.62% to.0.23%), p<0.001)), despite the significantly lower insulin dose at end of trial in the metformin group (1.04 IU/kg (95% CI 0.94 to 1.15)) compared with placebo (1.36 IU/kg (95% CI 1.23 to 1.51), p<0.001). The metformin group gained less weight (between-group difference -2.6 kg (95% CI -3.3 to -1.8), p<0.001). The groups did not differ with regard to number of patients with severe or non-severe hypoglycaemic or other serious adverse events, but the metformin group had more nonsevere hypoglycaemic episodes (4347 vs 3161, p<0.001). Conclusions: Metformin in combination with insulin did not reduce carotid IMT despite larger reduction in HbA1c, less weight gain, and smaller insulin dose compared with placebo plus insulin. However, the trial only reached 46% of the planned sample size and lack of power may therefore have affected our results.

U2 - 10.1136/bmjopen-2015-008376

DO - 10.1136/bmjopen-2015-008376

M3 - Journal article

C2 - 26916684

SN - 2044-6055

VL - 6

JO - BMJ Open

JF - BMJ Open

IS - 2

M1 - e008376

ER -

Metformin versus placebo in combination with insulin analogues in patients with type 2 diabetes mellitus: the randomised, blinded Copenhagen Insulin and Metformin Therapy (CIMT) trial

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